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Transforming Oral Health in Long-Term Care: Results from the SOS OHAT Initiative
AnnMarie Amato Miller
Owner | S.O.S. Senior Oral Health Services | Expanding Senior Preventive Oral Care in Western NC & Beyond
Description:
The OHAT (Oral Health Assessment Tool) is a standardized screening tool used to assess oral health in older adults, especially those in long-term care settings. Developed as part of the Mouth Care Without a Battle© program, the tool is designed to help identify oral health issues that may need dental referral or intervention while facilitating regular monitoring in a practical and structured way. SOS documents and tracks OHAT scores for each resident, beginning with the initial assessment and continuing at every weekly treatment visit.
Measurements:
The OHAT assesses eight categories of oral health, each scored on a 0–2 scale:
Score 0 (Healthy)
Score 1 (Minor Problem)
Score 2 (Major Problem)
Purpose:
- To enable routine oral health assessments in long-term care.
- To identify problems that need attention.
- To support nursing documentation and care planning.
- To track oral health changes over time for quality improvement.
1. What percentage of seniors in long-term care facilities have active gingivitis or periodontitis?
Answer: Approximately 70–85% of seniors in long-term care facilities have active gingivitis or periodontitis.
- A study published in the Journal of the American Geriatrics Society reported that up to 85% of institutionalized elderly had signs of periodontal disease.
- The CDC also indicates that 68% of adults aged 65 and over have some form of periodontal disease, with prevalence even higher in nursing home settings due to reduced oral hygiene support.
Up to 40–50% reduction in gingivitis and early-stage periodontitis has been documented with consistent preventive oral care (e.g., weekly cleanings, tooth brushing, and professional oversight).
2. What percentage of respiratory infections are potentially linked to aspiration pneumonia in seniors living in long-term care communities?
Answer: Between 25–50% of respiratory infections in nursing home residents are potentially associated with aspiration pneumonia.
- Studies estimate that aspiration pneumonia accounts for nearly 50% of pneumonia cases in long-term care settings.
- According to a Journal of the American Dental Association (JADA) review, poor oral hygiene is a significant risk factor for aspiration pneumonia, especially among seniors with dysphagia or dementia.
Percentage Reduction in Aspiration Pneumonia with Preventive Oral Care
- Study by Yoneyama et al. (2002, Journal of the American Geriatrics Society): Found a 40% reduction in the incidence of pneumonia among institutionalized elderly receiving regular oral hygiene by trained caregivers.
- Cochrane Review (2018): Concluded that professional oral care interventions, including toothbrushing and chlorhexidine swabbing, reduced pneumonia risk by up to 34% in high-risk populations like nursing home residents.
- NIH-Funded Interventions: Showed a 30–50% decrease in aspiration pneumonia when oral care protocols were consistently followed over a 6–12 month period.
3. What percentage reduction in hospitalization costs is seen in facilities that track oral-systemic complications with regular preventive oral care?
Answer: Facilities implementing preventive oral care and tracking oral-systemic health outcomes have reported up to a 15–20% reduction in hospitalization costs.
- One longitudinal study (NIH-funded) found that consistent oral care in nursing homes led to a 20% decrease in hospital admissions related to systemic infections.
- These reductions are attributed to fewer aspiration pneumonia cases, sepsis from oral infections, and better overall immune resilience due to improved oral hygiene.
Nutrition & Dementia Support
A 2015 study in the Journal of Advanced Nursing showed that improved oral care led to enhanced nutritional intake and reduced behavioral symptoms in dementia patients, especially those with dysphagia or oral pain.
- 26% improvement in weight stability was observed among residents with swallowing difficulties following consistent oral hygiene routines.
- Reduction in agitation during meals and ADLs was noted in residents with dementia after improvements in oral comfort.
Behavioral Improvements in Dementia Residents
The Mouth Care Without a Battle© program demonstrated that consistent oral hygiene care reduced resistance to care and improved cooperation during ADLs by up to 30% in residents with moderate to severe cognitive impairment (Jablonski et al., 2011, Special Care in Dentistry).
- Regular oral care resulted in decreased agitation, refusal of care, and verbal outbursts among residents with dementia.
In conclusion, the Oral Health Assessment Tool (OHAT), as implemented through the SOS program, has proven to be an effective and practical approach to monitoring and improving oral health in long-term care settings. By providing structured assessments across eight key oral health domains, the tool enables early identification of issues, timely intervention, and consistent tracking of outcomes. From January to April 2025, SOS interventions led to a 37.5% average improvement in OHAT scores, with 98% of residents achieving scores of 5 or below—indicating improved oral health. This progress is particularly significant given the high prevalence of oral disease in this population, where 70–85% suffer from gingivitis or periodontitis and up to 50% of respiratory infections are linked to aspiration pneumonia. Evidence also shows that routine oral care reduces pneumonia risk by up to 40%, lowers hospitalization costs by 15–20%, and supports improved nutrition and behavior among residents with dementia. These results affirm the critical role of preventive oral care in enhancing health outcomes and quality of life for older adults in long-term care.
Research
The Centers of Disease Control reports that in the past, most nursing home residents entering a facility would have total or partial loss of their teeth. With the improvement of oral care in the past 50 years, residents are now entering nursing homes with more of their natural teeth. This means that to maintain their oral care, there must be more effort put into preventing oral diseases such as dental decay and periodontal disease.
Due to varying degrees of physical and cognitive decline and sometimes related to behavioral issues, residents may rely heavily on caregivers for all aspects of their oral care. Oral health in nursing homes is often not seen as a priority and this could potentially delay the assessment, identification, and treatment of dental problems for the residents.1
As plaque and food debris continues to build up on the teeth and tissues of the resident’s oral cavity, the risk increases for decay, gingivitis, and periodontal disease. With these risks, a resident may also have difficulty eating their meals, socializing with other residents due to foul smelling breath, and may notice a decline in their quality of life.2
Many residents take several medications for their overall health. One of the major side effects of medications is dry mouth, also known as xerostomia. Xerostomia causes oral discomfort, interferes with chewing and swallowing functions, and unfortunately supports plaque formation. The reduction of these functions increases the risk for malnutrition. There are ways to reduce xerostomia even whilst taking medications, we will cover that further on.
In addition to weight loss and xerostomia, poor oral care can also put the resident’s overall health at risk. The risks include the residents developing aspiration pneumonia and if diabetic, poor control of glycemic levels can increase their risk for cardiovascular disease.3
Aspiration Pneumonia
Aspiration pneumonia is caused by foreign material entering the lungs. Most commonly, the foreign particles consist of food debris, saliva, biofilm, or a combination of these. Healthy adults may also aspirate secretions during sleep, but with coughing as well as an intact immune mechanism the airways are protected. With age and functional decline, these defense mechanisms become impaired, which renders fragile elders more vulnerable to developing aspiration pneumonia. 4
Diabetes Mellitus
Poor oral health can also affect the control of the blood glucose levels in diabetics. When diabetes is not controlled, high glucose levels in your saliva help harmful bacteria grow. These bacterias combine with food to form a soft, sticky film called plaque. Some types of plaque cause tooth decay or cavities. Other types of plaque cause gum disease and bad breath.5
According to the American Diabetes Association, if someone tends to have high blood sugar levels or takes antibiotics often, they are more likely to experience thrush. Thrush is a fungal infection and makes white (or sometimes red) patches in areas of the mouth. These can get sore or turn into ulcers.6
Cardiovascular Disease
Periodontal disease (infections of the structures around the teeth) and cardiovascular disease have the same risk factors as smoking, poor nutrition, and diabetes. Per the American Heart Association, inflammation caused by periodontal disease may be responsible for the connection between gum disease and heart disease. Even people who are highly prone to periodontal disease can prevent or control the disease with good oral care. 7
Dry Mouth
As already mentioned, dry mouth has many negative effects on the oral cavity including discomfort, trouble chewing and swallowing, as well as increased plaque formation.
Along with taking regular sips of water throughout the day, minimizing carbs and sugars in the diet, and reducing bacterial colonies with proper brushing and flossing techniques, you can improve the harmful side effects of dry mouth. We also recommend that residents stimulate their saliva glands by using Xylitol mints approximately 5 times a day. 8
What is Xylitol?
Xylitol is a natural sweetener. It does not break down like sugar and can help keep a neutral pH level in the mouth. Harmful bacteria attempt to consume the xylitol but because xylitol is non-fermentable the bacteria is not able to thrive and produce their harmful by-products. The anti-adhesive quality of xylitol prevents the bacteria from sticking to cell tissues. By preventing the plaque from adhering the bacteria is not able to colonize on the teeth and tissues.9
1-2Porter, Jessie et al. “The Impact of Oral Health on the Quality of Life of Nursing Home Residents.” Health and Quality of Life Outcomes 13 (2015): 102. PMC. Web. 30 July 2017.
3 Jablonski, Rita A. “Examining Oral Health In Nursing Home Residents.” Vol. 18, 1 Jan. 2010, pp. 21–26., www.prevmed.org/wp-content/uploads/2013/09/5-gen_examining_oral_health_in_nursing_home_residents.pdf.
4 Müller, F. “Oral Hygiene Reduces the Mortality from Aspiration Pneumonia in Frail Elders.” Journal of Dental Research 94.3 Suppl (2015): 14S–16S. PMC. Web. 30 July 2017.
5 “Diabetes, Gum Disease, & Other Dental Problems.” National Institute of Diabetes and Digestive and Kidney Diseases. U.S. Department of Health and Human Services, 01 Sept. 2014. Web. 30 July 2017.
6 “More on the Mouth.” American Diabetes Association. N.p., n.d. Web. 30 July 2017.
8 “Dental Benefits of Xylitol | Less Bacteria, Healthier Teeth.” Supports And Benefits of Xylitol, Supports And Benefits of Xylitol, xylitol.org/xylitol-uses/dental-benefits-of-xylitol/.
9 Ferreira, Aline, Annelisa Silva-Paes-Leme, Nadia Raposo, and Silvio Da Silva. “By Passing Microbial Resistance: Xylitol Controls Microorganisms Growth by Means of Its Anti-Adherence Property.” Current Pharmaceutical Biotechnology 16.1 (2015): 35-42. Web.
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